Targeting instruments, systems and methods of use

ABSTRACT

Instruments, implants, bone plates, systems and methods for correcting bone deformities and fractures in the lower extremity are disclosed. Specifically, targeting instruments, implants, bone plates, systems and methods used for correcting bone deformities and/or fractures in the foot are disclosed.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of PCT Application No.PCT/US2018/020053 filed on Feb. 27, 2018, which claims priority benefitunder 35 U.S.C. § 119(e) of U.S. provisional application No. 62/464,051filed Feb. 27, 2017, which is incorporated herein by reference in itsentirety.

FIELD OF THE INVENTION

The present invention relates generally to general surgery, podiatric,and orthopaedic instruments used for correcting bone deformities. Morespecifically, but not exclusively, the present invention relates toinstruments, implants, plates, systems and methods for correcting bonedeformities.

BACKGROUND OF THE INVENTION

Many currently available instruments used in conjunction with implantsfor correcting bone deformities and fractures use various alignmentmechanisms. The currently available instruments may experience problemswith adequate surgical exposure, alignment variability, inaccuratetargeting and instability. Thus, new instruments and methods of use areneeded to ensure proper and reproducible orientation of corrective orstabilization devices to be implanted into the foot and ankle.

SUMMARY OF THE INVENTION

Aspects of the present invention provide instruments, implants, plates,systems and methods for correcting bone deformities in the foot.

In one aspect, provided herein is a targeting guide. The targeting guideincludes a guide arm, at least one target member, at least one implantholder and a guide pin.

In another aspect, provided herein is a method of using the targetingguide to secure two bones together. The method includes, inserting theguide pin in a bone. The method also includes securing the guide arm tothe guide pin at the second end. In addition, the method includesinserting the protector member into the first end of the guide arm andthen inserting the target pin through the at least two bones that theuser wants to secure. Next, the method may including drilling a holeover the target pin and threading the target member into the drill holeto secure the two bones. The method may also include removing the guidepin, the target pin and the guide arm. Alternatively, the method mayfurther include attaching an implant holder to the guide arm, securingthe implant to the implant holder and positioning the implant over atarget location that may be the two bones to be secured.

These, and other objects, features and advantages of this invention willbecome apparent from the following detailed description of the variousaspects of the invention taken in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention andtogether with the detailed description herein, serve to explain theprinciples of the invention. The drawings are only for purposes ofillustrating preferred embodiments and are not to be construed aslimiting the invention. It is emphasized that, in accordance with thestandard practice in the industry, various features are not drawn toscale. In fact, the dimensions of the various features may bearbitrarily increased or reduced for clarity of discussion. Theforegoing and other objects, features and advantages of the inventionare apparent from the following detailed description taken inconjunction with the accompanying drawings in which:

FIG. 1 is a side perspective view of one embodiment of a targetingguide, in accordance with an aspect of the present invention;

FIG. 2 is a front perspective view of the targeting guide of FIG. 1, inaccordance with an aspect of the present invention;

FIG. 3 is a second front perspective view of the targeting guide of FIG.1, in accordance with an aspect of the present invention;

FIG. 4 is a second side perspective view of the targeting guide of FIG.1, in accordance with an aspect of the present invention;

FIG. 5 is an exploded view of the targeting guide of FIG. 1, inaccordance with an aspect of the present invention;

FIG. 6 is a side perspective view of the guide arm, in accordance withan aspect of the present invention;

FIG. 7 is a front end perspective view of the guide arm of FIG. 6, inaccordance with an aspect of the present invention;

FIG. 8 is a back end perspective view of the guide arm of FIG. 6, inaccordance with an aspect of the present invention;

FIG. 9 is a top perspective view of the guide arm of FIG. 6, inaccordance with an aspect of the present invention;

FIG. 10 is a side perspective view of the target member, in accordancewith an aspect of the present invention;

FIG. 11 is an exploded view of the target member of FIG. 10, inaccordance with an aspect of the present invention;

FIG. 12 is a side view of the guide pin, in accordance with an aspect ofthe present invention;

FIG. 13 is a side perspective view of the guide pin of FIG. 12, inaccordance with an aspect of the present invention;

FIG. 14 is an enlarged view of the pivot end of the guide arm with theinserted guide pin, in accordance with an aspect of the presentinvention;

FIG. 15 is a side perspective view of the implant holder, in accordancewith an aspect of the present invention;

FIG. 16 is an exploded view of the implant holder of FIG. 15, inaccordance with an aspect of the present invention;

FIG. 17 is a first perspective, side view of a portion of anothertargeting guide system with a protector member, in accordance with anaspect of the present invention;

FIG. 18 is a second perspective, side view of the portion of thetargeting guide system of FIG. 17, in accordance with an aspect of thepresent invention;

FIG. 19 is a first perspective, side view of the targeting guide systemof FIG. 17 with the protector member replaced with a drill guide, inaccordance with an aspect of the present invention;

FIG. 20 is a second perspective, side view of the targeting guide systemof FIG. 19, in accordance with an aspect of the present invention;

FIG. 21 is a perspective view of the targeting guide system of FIG. 19with a bone plate attached, in accordance with an aspect of the presentinvention;

FIG. 22 is another perspective view of the targeting guide system ofFIG. 21, in accordance with an aspect of the present invention;

FIG. 23 is an exploded perspective view of the complete targeting guidesystem of FIG. 17, in accordance with an aspect of the presentinvention;

FIG. 24 is another exploded, perspective view of the targeting guidesystem of FIG. 23, in accordance with an aspect of the presentinvention;

FIG. 25 is an exploded, first side view of the targeting guide system ofFIG. 23, in accordance with an aspect of the present invention;

FIG. 26 is an exploded, second side view of the targeting guide systemof FIG. 23, in accordance with an aspect of the present invention;

FIG. 27 is a dorsal view of the targeting guide system of FIG. 17positioned on a foot, in accordance with an aspect of the presentinvention;

FIG. 28 is a perspective view of the foot and targeting guide system ofFIG. 27 after a bone plate is secured to the foot with fasteners, inaccordance with an aspect of the present invention;

FIG. 29 is a perspective view of the foot and targeting guide system ofFIG. 28 after removal of the protector member and insertion of the drillguide, in accordance with an aspect of the present invention;

FIG. 30 is a perspective view of the foot of FIG. 29 after removal ofthe targeting guide system and insertion of a threaded member, inaccordance with an aspect of the present invention; and

FIG. 31 is a side view of the foot of FIG. 30 after removal of thetarget pin, in accordance with an aspect of the present invention.

DETAILED DESCRIPTION FOR CARRYING OUT THE INVENTION

Generally stated, disclosed herein are instruments, implants, plates,and systems for correcting bone deformities. Further, methods forcorrecting bone deformities using instruments, implants, plates, andsystems are discussed.

In this detailed description and the following claims, the wordsproximal, distal, anterior or plantar, posterior or dorsal, medial,lateral, superior and inferior are defined by their standard usage forindicating a particular part or portion of a bone or implant accordingto the relative disposition of the natural bone or directional terms ofreference. For example, “proximal” means the portion of a device orimplant nearest the torso, while “distal” indicates the portion of thedevice or implant farthest from the torso. As for directional terms,“anterior” is a direction towards the front side of the body,“posterior” means a direction towards the back side of the body,“medial” means towards the midline of the body, “lateral” is a directiontowards the sides or away from the midline of the body, “superior” meansa direction above and “inferior” means a direction below another objector structure. Further, specifically in regards to the foot, the term“dorsal” refers to the top of the foot and the term “plantar” refers thebottom of the foot.

Similarly, positions or directions may be used herein with reference toanatomical structures or surfaces. For example, as the currentinstrumentation and methods are described herein with reference to usewith the bones of the foot, the bones of the foot, ankle and lower legmay be used to describe the surfaces, positions, directions ororientations of the instrumentation and methods. Further, theinstrumentation and methods, and the aspects, components, features andthe like thereof, disclosed herein are described with respect to oneside of the body for brevity purposes. However, as the human body isrelatively symmetrical or mirrored about a line of symmetry (midline),it is hereby expressly contemplated that the instrumentation andmethods, and the aspects, components, features and the like thereof,described and/or illustrated herein may be changed, varied, modified,reconfigured or otherwise altered for use or association with anotherside of the body for a same or similar purpose without departing fromthe spirit and scope of the invention. For example, the instrumentationand methods, and the aspects, components, features and the like thereof,described herein with respect to the right foot may be mirrored so thatthey likewise function with the left foot. Further, the instrumentationand methods, and the aspects, components, features and the like thereof,disclosed herein are described with respect to the foot for brevitypurposes, but it should be understood that the instrumentation andmethods may be used with other bones of the body having similarstructures.

As shown in FIGS. 1-5, the targeting guide assembly may include a guidearm 110, a target member 120, an implant holder 130 and a guide pin 140.As seen FIGS. 1-2, the target member 120 extends through a through hole116 positioned at a first end 112 of the guide arm 110 and runsgenerally parallel to an elongate body or body 111 of the guide arm 110.The first end 112 of the guide arm 110 with the through hole 116 allowsfor ease of insertion and removal of the target member 120 toaccommodate various clinical circumstances and/or anatomic positionswithin the foot.

As seen in FIGS. 1 and 2, the implant holder 130 is placed on the body111 of the guide arm 110. The implant holder 130 is configured to slidealong a top surface of the body 111 to allow for location adjustability.Further, the guide arm 110 includes a second end 113 that is located atthe end of an angled portion 114 of the body 111.

The guide arm 110 is shown in FIGS. 6-9, and includes the first end 112that is connected to a second end 113 by the elongate body 111. Thefirst end 112 may, for example, include a wider portion 115 thatincludes arcuate sides that may attach the wider portion 115 in agenerally perpendicular direction relative to the body 111. The widerportion 115 also includes the through hole 116 that is sized to receivethe target member 120. It would be understood by one skilled in the artthat the hole 116 may be smaller and/or larger than as shown in FIGS.6-9 as the hole dimension will depend upon the size and configuration ofthe target member 120 that is used. The hole 116 is oriented in adirection to allow the target member 120 to extend parallel to the body111 of the guide arm 110.

The angled portion 114 extends in a downward angled direction from thebody 111 to the second end 113. Positioned at the second end 113 is ahousing element 117 that is configured to receive the guide pin 140. Asseen in FIGS. 6, 7, and 14, the housing element 117 includes an innersurface that is configured or sized and shaped to allow the guide pin140 to pivot, rotate or move in multiple planes. FIG. 14 also shows thathousing element 117 has a top opening 118 that is sized to allow for theinsertion of the guide pin 140. The bottom opening 119 may be slightlysmaller than the top opening 118 to capture and/or retain the guide pin140 within the inner cavity of the housing element 117.

FIGS. 12-13 show an embodiment of the guide pin 140 that may be insertedin the housing element 117. The guide pin 140 includes a shaft 141, asphere 142, a tip 143 and a tapered portion 144. The tip as shown inFIG. 12 is threaded, however, it is also contemplated that the tip mayhave a smooth outer surface to facilitate insertion. The sphere 142 issized and shaped or configured to be inserted into the housing element117, as shown in FIG. 14, to allow for a full range of pivoting motions,when in use. The tip 143 is configured or sized and shaped to allow forthe user to insert the guide pin 140 into a target bone either directlyor through the skin and then be secured therein to establish the targetlocation for the elongated target member 120.

With continued reference to FIGS. 12-13, the tapered portion 144 of theshaft 141 has a larger diameter proximate to the sphere 142 and thentapers down to a smaller diameter proximate to the tip 143. The taperedportion 144 functions to prevent the guide pin 140 from plunging orbeing inserted too deep into the target bone. The tapered portion 144also may operate to ensure accurate positioning of the guide pin 140 toaccomplish precise targeting functionality of the targeting guide 100.

Although not shown, the second end 113 may have an alternativeconfiguration which may include, for example, a universal joint, hingedjoint or other constrained mobile connection that could be utilized inplace of the spherical guide pin 140-housing element 117 assembly. Thehousing element 117 may include, for example, a movable joint constructthrough which a guide pin, Steinman pin, K-wire or other elongatedmember is connected and used to establish a target location in vivo.

Referring now to FIGS. 10-11, a target member 120 is shown. The targetmember 120 includes, for example, a three piece construct with aprotector member 121, a threaded member 122 and a target pin 123. Theprotector member 121 has a knob 124 and a cylindrical portion 125 thatare cannulated and can be coupled together. The protector member 121functions to protect the surrounding soft tissue when the target pin 123is inserted. As shown in FIG. 11, the threaded member 122 may have oneend that is tapered to facilitate insertion and placement in vivo. Theopposite end of the tube-like structure of the threaded member 122 hascutting flutes to facilitate the insertion of the target member intobone. The threaded member 122 may be cannulated or alternatively, besolid with no longitudinal opening. The threaded member 122, as seen inFIGS. 10 and 11, is threaded along its entire length, however, oneskilled in the art would contemplate using partially or segmentallydivided threads depending on the clinical application. The third pieceof the target member 120 is an elongated pin like structure 123. Theelongated pin like structure 123 may be, for example, a target pin,guide wire, k-wire or the like. The target pin 123 as shown, may have,for example, a smooth outer surface with a one sharpened end. When inuse, typically the target pin 123 is inserted first from a distal toproximal direction with the pin 123 passing through the cannulatedpassage of the protector member 121 and threaded member 122 when thisconstruct is being threaded into a bone pathway to secure the targetingguide in the surgical site and allow for the establishment of a targetlocation proximally. The fully assembled targeting guide 100 is shown inFIGS. 1-4 with the target member 120 in place.

Further, FIG. 5 shows an exploded view of the targeting guide 100 andthe disassembled target member 120. It will be understood by one ofordinary skill in the art that the target member 120 shown is oneembodiment and that other constructs are also contemplated, for example,a one piece rod like structure, with or without threads, oralternatively, a two piece structure that includes threaded andnon-threaded elements.

Referring now to FIGS. 1-4 and 15-16 the implant holder is shown. Theimplant holder may be detachably attached to the body 111 of the guidearm 110. The implant holder 130 includes a locking member 131, a housing132, an attachment arm 133 and an alignment post 134. The locking member131 is positioned in a hole that has an opening at the top surface ofthe housing 132 and exits through an opening on the bottom surface ofthe housing 132. The locking member 131 includes a knob 135 that allowsthe user to turn the locking member 131, a shaft 137 that is connectedto the knob 135, and a threaded portion 138 of the shaft 137 ispositioned at the opposite end of the knob 135. As seen in FIG. 15, whenassembled, the shaft 137 of the locking member 131 is wholly containedwithin the housing as it passes through a through hole in the housing132. The implant holder 130 also has an alignment post 134 that isadjacent to the threaded portion 138. The implant holder 130 further hasan attachment arm 133 that is generally configured as a hook likestructure. The attachment arm 133 hooks over the top of the body 111 ofthe guide arm 110 to permit the sliding movement along the longitudinalaxis of the body 111, as shown in FIGS. 1-4. The threaded portion 138 ofthe implant holder 130 may be, for example, secured to a bone plate. Thethreaded portion 138 may be threaded into a corresponding hole in theplate and the alignment post 134 is positioned within a second hole inthe surface of the plate to secure the plate to the implant holder 130and allow the user to move the secured implant along the length of thebody 111.

A surgical method for correcting bone deformities using the targetingguide instrument of FIGS. 1-16 is disclosed. The method includes, forexample, performing an arthrodesis across a minimum of one joint. Aminimum of two bones are positioned in their desired final position andcan be fixed temporarily via various means. The guide pin 140 sets thetrajectory for the target pin 123 and the threaded member 122. Themethod includes further the placing of the guide pin 140 in a bone suchthat the trajectory of the target pin 123 will triangulate to thethreaded portion 143 of the guide pin 140. The configuration of theguide arm 110 may provide guidance as to the location along the threadedportion 143 of the guide pin 140 where the target pin 123 will aim. Theguide arm 110 may be adjusted for bones where the user may want to placethe guide pin 140 deeper to allow for better fixation, while aimingcloser to the edge or cortical surface of the bone. Next, the method mayinclude attaching the housing element 117 of the guide arm 110 to thesphere 142 of the guide pin 140. Further, the method may include placingthe protector member 121 in the hole 116. A target pin 123 may be placedinto the protector member 121 and inserted past at least two bones butmay be inserted to or past the threaded portion 143 of the guide pin140. The method may include removing the protector member 121 by slidingit out of the guide arm 110. The guide arm 110 is removed from thesphere 142 of the guide pin 140. The guide pin 140 may also be removedat this time or can be removed at a later time. A cannulated drill maybe used to drill over the target pin 123. The threaded member 122 isthen inserted over the target pin 123 to the desired depth.Alternatively, if the threaded member 122 is not cannulated, the targetpin 123 can be removed and the threaded member 122 inserted through thedrill hole.

In one embodiment, the method may also include using an implant holder130. The implant holder 130 is attached to an implant (not shown). Theimplant may be, for example, a bone plate. The implant holder 130 may beattached to the guide arm 110 prior to placement on the guide pin 140,or can be placed after the guide arm 110 is placed on the guide pin 140.Likewise, the implant may be attached to the implant holder 130 prior toplacement on the guide arm 110 or may be pre-assembled and then theimplant holder 130 is attached to the guide arm 110. The implantposition may be adjusted along the length of the guide arm 110 to allowfor implant positioning along a first plane. For example, along thesagittal plane. Alternatively, the guide arm 110 can be rotated aroundthe guide pin 140 to rotate the plate in a second plane, for example thefrontal plane. Movement of the implant in these two planes allows forfixation devices to be inserted with a trajectory to avoid contactingthe threaded member 122. The implant may secured with locking ornon-locking fixation devices prior to placement of the guide pin 140.Alternatively, the implant may be secured after the placement of theguide pin 140.

A method of assembling the targeting guide 100 includes obtaining aguide arm 110 and a guide pin 140. Placing the guide pin 140 in a bone.The method may further include attaching the guide arm 110 to the guidepin 140 at the second end 113 and inserting the protection member 121into the hole 116. Further, the method may include inserting the targetpin 123 through the protection member 121 and then removing theprotection member 121 from the hole 116.

Referring now to FIGS. 17-31, another targeting guide assembly 200 isshown. The targeting guide assembly 200 includes a guide arm 210, atarget member 230, an implant holder 260, and a guide pin 290. Thetarget member 230 is received within a first end of the guide arm 210.The implant holder 260 moveably engages the guide arm 210 and may, forexample, slide along a top surface of a body 212 of the guide arm 210 toallow for location adjustability of a bone plate 300, as shown in FIGS.28 and 29. The guide pin 290 rotatably couples to the second end of theguide arm 210. The implant holder 260 couples to a bone plate 300.

As shown in FIGS. 17-26, the guide arm 210 includes a body 212connecting a first end 214 and a second end 216 of the guide arm 210.The first end 214 may, for example, include a wider portion 220 thatincludes arcuate sides that may attach the wider portion 220 in agenerally perpendicular direction relative to the body 212. The widerportion 220 may also include a through hole 222 that is sized and shapedto receive the target member 230. The through hole 222 may be, forexample, larger or smaller than as shown in FIGS. 17-26. The throughhole 222 may extend through the wider portion 220 parallel to the body212 allowing the target member 230 to extend parallel to the body 212 ofthe guide arm 210. The second end 216 may, for example, include anangled portion 218. The angled portion 218 extends in a downward angleddirection from the body 212 to the second end 216. A housing element 224may be positioned at the second end 216 and be configured or sized andshaped to receive the guide pin 290. The housing element 224 may includea top opening 226 and a bottom opening 228 forming an inner surface orcavity extending between the top opening 226 and the bottom opening 228.The housing element 224 may also include a channel extending from anexterior surface of the housing element 224 into the inner surface. Theinner surface may be, for example, configured or sized and shaped toallow the guide pin 290 to pivot, rotate, or move in multiple planes.The top opening 226 may be sized to allow for insertion of a sphere 294of the guide pin 290 into the housing element 224. The bottom opening228 may be, for example, slightly smaller than the top opening 226 tocapture or retain the guide pin 290 within the inner cavity of thehousing element 224.

The target member 230 is shown in FIGS. 17-26 and includes a target pin232, a protector member 234, a drill guide 240, and a threaded member orimplant 250 (shown in FIGS. 23-26). The target pin 232 may be, forexample, a guide wire, k-wire, pin, or the like elongated pin likestructure or member for insertion through a joint. In the depictedembodiment the target pin 232 has a smooth outer surface with a point orsharped portion at one end.

The target pin 232 may be, for example, inserted from a distal toproximal direction through the cannulated opening of the protectormember 234 when inserted into a bone pathway to secure the targetingguide in the surgical site and allow for the establishment of a targetlocation proximally. The protector member 234 may include a knob 236 ata first end of a cylindrical portion 238. The protector member 234 mayalso include a through hole or cannulated opening extending through theprotector member 234 along a longitudinal axis of the protector member234. The protector member 234 may, for example, protect the surroundingsoft tissue when the target pin 232 is inserted through the protectormember 234 and into a patient's bones. The drill guide 240 may include acylindrical portion 242 and a knob 244 positioned at a first end of thecylindrical portion 242. The cylindrical portion 242 of the drill guide240 may have, for example, a larger diameter than the cylindricalportion 238 of the protector member 234. The drill guide 240 may alsoinclude a through hole or cannulated opening 246 extending along alongitudinal axis of the drill guide 240. The drill guide 240 may, forexample, protect the surrounding soft tissue when a drill is insertedthrough the cannulated opening 246 to drill an opening for inserting thethreaded member 250. The threaded member or implant 250 may include ahead portion 252 at a first end of the threaded member 250 and cuttingflutes 254 at a second end of the threaded member 250. The cuttingflutes 254 may facilitate the insertion of the threaded member 250 intobones. In addition, the threaded member 250 may include a through holeor cannulated opening 256 extending through the threaded member 250along a longitudinal axis. The through hole 256 may be configured orsized and shaped to receive the target pin 232. Alternatively, thethreaded member 250 may be, for example, solid without a longitudinalopening. As shown, the threaded member 250 is threaded along the entirelength, however, it is also contemplated that the threaded member 250may be threaded along only a portion, for example, having partially orsegmentally divided threads along the length.

The implant holder 260 may include a housing 262, a knob 274 and alocking member 280. The housing 262 may include an attachment arm 264extending from and parallel to the housing 262 to form, for example, aU-shaped or hook like structure. The attachment arm 264 hooks under thebottom of the body 212 of the guide arm 210 to permit the slidingmovement along the longitudinal axis of the body 212. A channel 266 isformed between the attachment arm 264 and the housing 262. Theattachment arm 264 may also include at least one hole 268 extendingthrough the attachment arm 264 from an exterior surface into the channel266. The at least one hole 268 may be, for example, three holes. Theimplant holder 260 may also include an alignment post 270 extending awayfrom a bottom surface of housing 262. The implant holder 260 may furtherinclude a through hole 272 extending through the housing 262 from a topsurface to a bottom surface adjacent to the alignment post 270. The knob274 may include an engagement protrusion 276 extending away from a backsurface of the knob 274. The engagement protrusion 276 may be, forexample, threaded to engage the at least one hole 268 to secure theimplant holder 260 to the body 212 of the guide arm 210 at the desiredposition. The locking member 280 may include a shaft 282 with a knob 284at a first end and a threaded portion 286 at a second end. The shaft 282may be inserted through the through hole 272 of the housing 262 untilthe knob 284 contacts a top surface of the housing 262 and the threadedportion 286 extends past the bottom surface of the housing 262. Thethreaded portion 286 may engage a bone plate, such as bone plate 300, asdescribed in greater detail below. The knob 274 may be rotated to insertthe threaded portion 286 into the bone plate 300 and to remove thethreaded portion 286 from the bone plate 300.

As shown in FIGS. 17-26, the guide pin 290 includes a shaft 292, asphere 294, a tip 296, and a cylindrical protrusion 298. The sphere orspherical member 294 may be positioned between a first end and the tip296. The tip 296 is threaded, however, it is also contemplated that thetip 296 may also have a smooth outer surface to facilitate insertion.The tip 296 is configured or sized and shaped to allow for the user toinsert the guide pin 290 into a target bone either directly or throughthe skin. Once inserted into the target bone, the guide pin 290 may besecured to establish the target location for the threaded member 250.The sphere 294 is sized and shaped or configured to be inserted into thehousing element 224 to allow for a full range of pivoting motions, asshown in FIGS. 17-22 and 27-29. The cylindrical protrusion 298 may bepositioned adjacent to the sphere 294 between the sphere 294 and the tip296.

The targeting guide assembly 200 may be assembled by inserting the guidepin 290 into the housing element 224 of the guide arm 210. The protectormember 234 may be inserted into the through hole 222 of the guide arm210 to receive the target pin 232. In addition, the implant holder 260may be aligned with the body 212 of the guide arm 210 and secured in thedesired position by engaging the engagement protrusion 276 with the body212. The locking member 280 may be inserted into the opening 272 of thehousing 262. Then, the alignment post 270 may be aligned with acorresponding alignment opening (not shown) in the bone plate 300 andthe threaded portion 286 of the locking member 280 may engage acorresponding threaded opening (not shown) in the bone plate 300. Inaddition, the protector member 234 may be removed and the drill guide240 may be inserted into the through hole 222 of the guide arm 210 overthe target pin 232.

Referring now to FIGS. 27-31, a method for using the targeting guideassembly 200 to correct bone deformities is shown. The method mayinclude, for example, performing an arthrodesis across at least onejoint. The at least two bones of the at least one joint may bepositioned in a desired final position and may be temporarily fixed. Asshown in FIG. 27, the method may also include inserting a guide pin 290into a first bone 350 to set the trajectory for the target pin 232 andthe threaded member 250. Next, the housing element 224 of the guide arm210 may be coupled to the sphere 294 of the guide pin 290. The guide arm210 may be rotated about the sphere 294 to position the first end 214 ofthe guide arm 210 with respect to a second bone 352. Next, the protectormember 234 may be inserted into the through hole 222 and a target pin232 may be inserted through the protector member 234 and into at leastone bone 352, 354, 356, 350. The trajectory of the target pin 232 willoverlap or engage the guide pin 290. In one embodiment, the implantholder 260 may be coupled to the guide arm 210 before the guide arm 210is coupled to the guide pin 290. Alternatively, the implant holder 260may be coupled to the guide arm 210 after the target pin 232 is insertedinto the bones 352, 354, 356, 350. The bone plate 300 may then becoupled to the implant holder 260 and aligned on the bones 352, 354,356, 350, as shown in FIG. 28. It is also contemplated that the boneplate 300 may be coupled to the implant holder 260 prior to the guidearm 210 being coupled to the guide pin 290. Once the bone plate 300 iscoupled to the implant holder 260, the position of the implant 300 maybe adjusted along the length of the guide arm 210 to allow for implantpositioning in a first plane, for example, the sagittal plane. The guidearm 210 may alternatively or in addition to adjustment along the lengthbe rotated around the guide pin 290 to rotate the bone plate 300 in asecond plane, for example, the frontal plane. Movement of the bone plate300 in the two planes allows for fixation devices or bone screws 340 tobe inserted with a trajectory to avoid contacting the target pin 232and/or threaded member 250. The bone plate 300 may be secured to thebones 352, 354, 356, 350 with bone fasteners 340 inserted to avoidcontacting the target pin 232 and the threaded member 250 when inserted.The bone fasteners or fixation devices 340 may be, for example, lockingor non-locking fasteners. The method may then include removing theprotector member 234 by sliding the protector member 234 out of thethrough hole 222 of the guide arm 210 over the target pin 232. As shownin FIG. 29, the drill guide 240 may then be inserted through the throughhole 222 over the target pin 232 and positioned onto a bone 352. Acannulated drill may be used to drill over the target pin 232. Thecannulated drill and drill guide 240 may then be removed from the guidearm 210 and the threaded member 250 may be inserted over the target pin232 and into the bones 352, 354, 356, 350, as shown in FIG. 30. Althoughnot shown, it is also contemplated that the bone plate 300 may becoupled to the bones 352, 354, 356, 350 after the threaded member 250 isinserted into the bones 352, 354, 356, 350. As also shown in FIG. 30,the guide arm 210 and guide pin 290 may be removed from the bones 352,354, 356, 350. Finally, as shown in FIG. 31, the target pin 232 may beremoved from the bones 352, 354, 356, 350 and the threaded member 250.

As may be recognized by those of ordinary skill in the art based on theteachings herein, numerous changes and modifications may be made to theabove-described and other embodiments of the present disclosure withoutdeparting from the scope of the disclosure. The components of theinstruments, guides, implants, plates, and/or systems as disclosed inthe specification, including the accompanying abstract and drawings, maybe replaced by alternative component(s) or feature(s), such as thosedisclosed in another embodiment, which serve the same, equivalent orsimilar purpose as known by those skilled in the art to achieve thesame, equivalent or similar results by such alternative component(s) orfeature(s) to provide a similar function for the intended purpose. Inaddition, the instruments, guides, implants, plates, and/or systems mayinclude more or fewer components or features than the embodiments asdescribed and illustrated herein. For example, the components andfeatures of FIGS. 1-16 and FIGS. 17-31 may be used interchangeably andin alternative combinations as would be modified or altered by one ofskill in the art. Further, the steps of the surgical methods associatedwith FIGS. 1-16 and FIGS. 17-31 may be used interchangeably and inalternative combinations as would be modified or altered by one of skillin the art. Accordingly, this detailed description of thecurrently-preferred embodiments is to be taken in an illustrative, asopposed to limiting of the disclosure.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention. Asused herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprise” (andany form of comprise, such as “comprises” and “comprising”), “have” (andany form of have, such as “has”, and “having”), “include” (and any formof include, such as “includes” and “including”), and “contain” (and anyform of contain, such as “contains” and “containing”) are open-endedlinking verbs. As a result, a method or device that “comprises,” “has,”“includes,” or “contains” one or more steps or elements possesses thoseone or more steps or elements, but is not limited to possessing onlythose one or more steps or elements. Likewise, a step of a method or anelement of a device that “comprises,” “has,” “includes,” or “contains”one or more features possesses those one or more features, but is notlimited to possessing only those one or more features. Furthermore, adevice or structure that is configured in a certain way is configured inat least that way, but may also be configured in ways that are notlisted.

The invention has been described with reference to the preferredembodiments. It will be understood that the operational embodimentsdescribed herein are exemplary of a plurality of possible arrangementsto provide the same general features, characteristics, and generalsystem operation. Modifications and alterations will occur to othersupon a reading and understanding of the preceding detailed description.It is intended that the invention be construed as including all suchmodifications and alterations.

Having thus described the preferred embodiment, the invention is nowclaimed to be:
 1. A targeting guide assembly, comprising: a guide arm,comprising: a body extending between a first end and a second end of theguide arm; a wider portion at the first end, wherein the wider portionextends from the body in a perpendicular direction; and an angledportion extending in a downward direction from the body to the secondend, the second end comprising a housing element positioned at an end ofthe angled portion opposite the body, the housing element comprising: atop opening; a bottom opening; an inner cavity formed by the top openingengaging the bottom opening, the inner cavity comprising a sphere shapeto receive a corresponding sphere of a guide pin; and a channelextending into the inner cavity from an exterior surface of the housingelement; a target member coupled to the guide arm; and the guide pinthat is movably engaged to an end of the guide arm.
 2. The targetingguide assembly of claim 1, wherein the wider portion further comprises:a through hole extending along a longitudinal axis of the guide arm,wherein the through hole receives the target member.
 3. The targetingguide assembly of claim 1, wherein the targeting member comprises: atarget pin with a first end and a second end; a protector member forinsertion through a through hole of the guide arm and for receiving thetarget pin; a drill guide for insertion into the through hole of theguide arm over the target pin; and a threaded member for insertionthrough the through hole of the guide arm.
 4. The targeting guideassembly of claim 3, wherein the protector member comprises: acylindrical portion; a knob positioned at an end of the cylindricalportion; and an opening extending through the cylindrical portion andthe knob along a longitudinal axis of the protector member.
 5. Thetargeting guide assembly of claim 4, wherein the drill guide comprises:a cylindrical portion; a knob positioned at an end of the cylindricalportion; and a cannulated opening extending through the cylindricalportion and the knob along a longitudinal axis of the drill guide. 6.The targeting guide assembly of claim 5, wherein the threaded membercomprises: a head portion positioned at a first end of the threadedmember; at least one cutting flute positioned at a second end of thethreaded member; a cannulated opening extending through the threadedmember along a longitudinal axis; and a thread positioned along at leasta portion of an exterior surface of the threaded member.
 7. Thetargeting guide assembly of claim 6, wherein the guide pin comprises: ashaft with a first end and a second end; a spherical member coupled tothe shaft between the first end and the second end, wherein thespherical member is rotatably inserted into the inner cavity of thehousing element; and a tip positioned at the second end of the shaft. 8.The targeting guide assembly of claim 7, wherein the guide pin furthercomprises: a cylindrical protrusion positioned adjacent to the sphericalmember and between the spherical member and the tip.
 9. The targetingguide assembly of claim 8, further comprising: a holder, wherein theholder is slidably coupled to a body of the guide arm.
 10. The targetingguide assembly of claim 9, wherein the holder comprises: a housing witha top surface and a bottom surface; a knob rotatably coupled to thehousing; a locking member extending through an opening in the housing;an attachment arm extending away from the bottom surface of the housingand toward the top surface of the housing parallel to the housing; achannel formed between the housing and the attachment arm; and analignment post extending away from the bottom surface of the housingadjacent to the opening in the housing for receiving the locking member.11. The targeting guide assembly of claim 10, wherein the housing andattachment arm form a U-shaped structure.
 12. The targeting guideassembly of claim 10, wherein the attachment arm comprises: at least oneopening extending from an exterior surface through the attachment arm tothe channel.
 13. The targeting guide assembly of claim 12, wherein anengagement protrusion of the knob is inserted into the at least oneopening of the attachment arm to couple the holder to the body of theguide arm.
 14. The targeting guide assembly of claim 13, wherein thelocking member comprises: a shaft, wherein the shaft engages the openingof the housing; a knob positioned at a first end of the shaft; and anengagement portion positioned at the second end of the shaft forcoupling with a bone plate.
 15. The targeting guide assembly of claim14, wherein the bone plate comprises: a top surface opposite a bottomsurface; an alignment opening for receiving the alignment post of theholder; an engagement opening for receiving the engagement portion ofthe locking member of the holder to couple the targeting guide assemblyto the bone plate; and a plurality of openings extending from the topsurface to the bottom surface, and wherein the plurality of openingsreceive a plurality of bone fasteners.
 16. A targeting guide assembly,comprising: a guide pin; a guide arm, comprising: a body extendingbetween a first end and a second end of the guide arm; a first portionat the first end extending from the body; and an angled portionextending in a downward direction from the body to the second end, thesecond end comprising a housing element positioned at an end of theangled portion and comprising: a top opening and a bottom openingarranged on opposite surfaces of the housing element, the top openingand the bottom opening defining a channel extending therebetween andestablishing fluid communication between the top opening and the bottomopening; a cavity disposed at least partially within one or more of thetop opening, the bottom opening, and the channel and comprising aspherical geometry complimentary to that of at least a portion of theguide pin; and a target member coupled to the guide arm.
 17. Thetargeting guide assembly of claim 16, wherein the guide pin isconfigured to be received by and at least partially within the channel.18. The targeting guide assembly of claim 17, wherein the at least aportion of the guide pin comprises at least one protrusion positionedalong a length of the guide pin, the protrusion having a geometrycomplimentary to that of the cavity.
 19. The targeting guide assembly ofclaim 16, wherein the first portion at the first end of the guide arm iswider than the angled portion at the second end of the guide arm, andwherein the first portion at the first end of the guide arm extends fromthe body in a perpendicular direction and comprises a through holeextending along a longitudinal axis of the guide arm, the through holeconfigured to receive the target member and releasably couple the targetmember with the guide arm.